NHS Performance Indicators : July 2000 FOREWORD

Foreword

The consultation document A First Class Service: Quality in the New NHS, published in July 1998, highlighted the determination of the Government and the NHS Executive to work in partnership with patients and the staff of the NHS to deliver high quality care. It set out a three part approach to improving quality - new national standards; dependable local delivery systems; and improved monitoring and performance assessment.

For the second year we are publishing information on High Level Performance and Clinical Indicators, providing information about individual NHS hospital Trusts and Health Authorities. This publication brings both sets of indicators together into a single, more accessible document.

Following widespread consultation prior to the publication of the first set of indicators last year we have continued to work with clinicians and managers in the NHS to improve the coverage of the indicators. This set has been developed to reflect key Government priorities, such as cancer services, and those set out in the White Paper Saving Lives and the new National Service Frameworks; it has been expanded to cover indicators for primary care and indicators in response to the National Survey of NHS Patients.

The quality of the data used in these indicators has improved since last year, and I would like to acknowledge the contribution of the NHS in this respect.

This summer the Government will be publishing the National Plan for the NHS, building on public consultation and the advice received from the modernisation action teams which have included senior national stakeholders and frontline NHS staff. The historic four year package of funding announced in the Budget will provide the resources necessary for modernisation; the National Plan will provide the necessary framework for us to address variations in performance and in the standards and quality of care.

The NHS Performance Indicators are an important part of this process. They underpin the Performance Assessment Framework, published last year, which introduced a new broader-based approach to assessing performance in the NHS by focusing on the things that matter most to patients and the public: the quality of services as well as the efficiency of service delivery.

Neil McKay

Acting Chief Executive of the NHS Executive

Introduction

The new NHS made a commitment to a National Health Service which - by delivering quick, high quality, better-integrated services which reduce health inequalities - will secure better health for the population. It promised to concentrate on assessing what matters to patients and the public - the delivery of quality and cost-effective care that leads to improved health. Quality and efficiency need to be pursued together, since just as resources need to be used efficiently and to best effect so must services be provided to consistent standards of quality.

A First Class Service set out a package of proposals to support the delivery of more consistent and higher quality care to patients, and to drive performance improvement. The main elements of the package set out in A First Class Service are:

• setting clear national standards, through National Service Frameworks and the National Institute for Clinical Excellence;
• delivering high quality care locally through clinical governance underpinned by modernised professional self-regulation and extended lifelong learning;
• monitoring quality standards through the Commission for Health Improvement, the NHS Performance Assessment Framework and the National Survey of Patient and User Experience.

The diagram below provides a simple illustration of the key elements of the NHS quality strategy.

Figure 1 A simple illustration of the key elements of the NHS quality strategy(from A First Class Service)

Performance assessment is central to all these activities. A First Class Service highlighted the need for a performance framework which would support the drive for higher quality standards by ensuring that performance assessment is focused on the delivery of clinically and cost effective, appropriate and timely health services to meet local needs.

The NHS Performance Assessment Framework, published in April 1999, introduced a new broader-based approach to assessing performance in the NHS by encouraging action across six areas (shown in the diagram below). The Framework was supported by the publication in June 1999 of the first sets of High Level Performance Indicators (HLPIs) and Clinical Indicators (CIs).

This publication brings together in one document an updated and expanded set of NHS Performance Indicators. The indicators in this document are organised into six chapters - one each for the six areas of the Performance Assessment Framework - and are published in easy to use graphs, which enable comparisons to be made between the performance of different health authorities and NHS trusts.

This second indicator set has been developed to reflect more closely key Government priorities for health. Future sets of indicators will continue to be developed in line with these priorities. This set includes: more indicators linked to cancer services; indicators which reflect key targets in the Mental Health and Coronary Heart Disease National Service Frameworks; new indicators reflecting primary care and the results of the National Survey of NHS Patients; a range of indicators reflecting the priorities of the Saving Lives White Paper. There are also three "interface" indicators, common to both NHS and Personal Social Services Frameworks, which will continue to support joint performance assessment by the NHS and Social Services. This indicator set shows NHS performance at a wider level and offers a clear, objective view of how well the NHS is working.

Using the Framework to make improvements is an ongoing process and will require changes locally. The indicator set presented here supports the Framework. The indicators are not direct measures of quality but should be used to draw attention to issues that may need further investigation or action. This means that Health Authorities, Primary Care Groups/Trusts and NHS Trusts should continue to use the Framework and the new indicator set in drawing up Health Improvement Programmes. They should also work together to ensure that robust Clinical Governance processes are in place including clinical audit, that data are quality assured and that local enquiry and learning is encouraged through CPD and life-long learning.

The circular presentation of the six areas of the Framework in figure 2 reinforces the inter-dependence of the six areas. From an initial view of the health of the diverse communities of the local population under consideration (Health Improvement), we need to ensure that everyone with health care needs (Fair Access) receives appropriate and effective health care (Effective Delivery) offering good value for money for services (Efficiency) as sensitive and convenient as possible (User/Carer Experience) so that good clinical outcomes are achieved (Health Outcome of NHS Care), to maximise the contribution to improved health (back to Health Improvement).

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Last updated July 2000.